Blood test results, please comment

[Gal_Ka]

T3 Reverse 90.0 (92-241) pg/ml

T3 free 3.0. (3.0-5.6) pmol/L

T4 free 12.24 ( 9.0-19.05)pmol/L

TSH 3.41 (0.4-4.0) IU/L

TPO 59.9 ( < 5.6 ) IU/ml

TG < 3.0 (< 4.11 ) IU/ml

Ferritin 54 (10-120) mkg/L

B12 566 (187-883) pg/ml

Folic acid 12.8 (3.1-20.5) ng/ml

25(OH)D 52 (30-100) ng/mg

LDL cholesterol 4.53 (<3.0)

HDL cholesterol 2.26 (> 1.2)

Non high density cholesterol 4.75 (<3.8)

Cholesterol 7.01 ( <5.0 )

Triglyceride 0.47 (< 1.7 )

Haemoglobin A1c level 43 (20-41)

eGFR using creatinine 67 (>89) per 1.73 sq m mL/min

[SlowDragon Ambassador]

Looking at previous posts

Are you still only on 50mcg levothyroxine

This is only the standard starter dose

Was test done early morning and last dose levothyroxine 24 hours before test

FT4: 12.24 pmol/l (Range 9 - 19.5)

Ft4 only 30.86% through range

Most people on just levothyroxine, when adequately treated will have Ft3 at least 50-60% through range and Ft4 (levothyroxine) often needs to be little higher at 70-80% through range

Low Ft4 and rock bottom Ft3 clearly show you are not on high enough dose levothyroxine

How long have you been on just 50mcg levothyroxine

Get dose increase to 75mcg daily

You may initially need to increase slowly to 50mcg and 75mcg on alternate days …..after 4-6 weeks increase to 75mcg daily

Retest thyroid levels again in another 2 months

Likely to need further increase in levothyroxine after next test

[Gal_Ka in reply to SlowDragon]

Thank you for your reply.

I am on levothyroxine (Tirosint 50mcg recently) for more than 12 years. I had symptoms rarely and NHS was following just T4free and TSH and they were happy with it. My cholesterol used to get better only when I was on a strict veg diet.

The latest test was done privately - early morning no Levo for 24 hours. I just started to worry about the Haemoglobin A1c as NHS has detected it got out of range. There were no changes in my lifestyle, I am slim, energetic, on vegs and fish diet, rare thyroid symptoms. However, some metabolic changes are taking place. Just wonder if I increase the dosage will my glucose go down as well?

[SlowDragon Ambassador in reply to Gal_Ka]

Just wonder if I increase the dosage will my glucose go down as well?

Yes likely to

Approx how much do you weigh in kilo

Guidelines on dose by weight is approximately 1.6mcg Levo per kilo of your weight per day

[Gal_Ka in reply to SlowDragon]

I see…this means my dose is 93mcg. The thing is I used to think I can come off Levo as it is the only drug I take. Once I managed to get off and in 8 months I got unpleasant symptoms back, I started taking 25mcg for a couple of years or so and later I got back on 50 mcg.

I was thinking if I feel practically symptoms free then my dose is ok.

Just wonder - if you are under medicated can you develop nodes in your thyroid? And also can dental implants worsen symptoms in Hashimoto?

[SlowDragon Ambassador in reply to Gal_Ka]

your results show your body is hypothyroid

High cholesterol

Low GFr

Levothyroxine is not a medication, it’s replacement thyroid hormones, because your own thyroid is no longer working correctly

Just like a diabetic ALWAYS needs insulin

A Hypothyroid patient will ALWAYS need replacement thyroid hormones

When adequately treated on high enough dose Levothyroxine, symptoms will disappear

[SlowDragon Ambassador in reply to Gal_Ka]

Even if we frequently start on only 50mcg, most people need to increase levothyroxine dose slowly upwards in 25mcg steps (retesting 6-8 weeks after each increase) until eventually on, or near full replacement dose

NICE guidelines on full replacement dose

nice.org.uk/guidance/ng145/...

1.3.6

Consider starting levothyroxine at a dosage of 1.6 micrograms per kilogram of body weight per day (rounded to the nearest 25 micrograms) for adults under 65 with primary hypothyroidism and no history of cardiovascular disease.

Also here

cks.nice.org.uk/topics/hypo...

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[SlowDragon Ambassador]

Cholesterol is high because you are hypothyroid and should reduce as dose levothyroxine is increased up over coming months

nhs.uk/conditions/statins/c...

If you have an underactive thyroid (hypothyroidism), treatment may be delayed until this problem is treated. This is because having an underactive thyroid can lead to an increased cholesterol level, and treating hypothyroidism may cause your cholesterol level to decrease, without the need for statins. Statins are also more likely to cause muscle damage in people with an underactive thyroid.

Similarly GFR is low because you are hypothyroid

Kidney function will improve as thyroid levels improve

ncbi.nlm.nih.gov/pmc/articl...

There is a reversible reduction in the kidney to body weight ratio in hypothyroidism, where the renal mass almost doubles with treatment. Hypothyroidism results in a reversible elevation in serum creatinine due to the reduction in GFR as well as possible myopathy and rhabdomyolysis. There is a reduction in serum cystatin C levels in hypothyroidism due to reduced production, consequent to reduced cellular metabolism.[30] Both these changes are reversible with treatment of hypothyroidism.

[Gal_Ka in reply to SlowDragon]

Thank you for your reply.

I refused to take statins and when I am on strict veg diet sometimes the cholesterol goes a bit down though it is always out of range for more than 10 years - the period I am on levo 50 mcg. It seems levo never managed to put my cholesterol down. As to GFR

[Gal_Ka in reply to Gal_Ka]

GFR was always slightly out of the range and NHS never suggested to increase the dose of levo or to give me a chance to be seen by an endocrinologist.

[SlowDragon Ambassador in reply to Gal_Ka]

GP frequently has very poor understanding of how significantly hypothyroidism affects patients

Levothyroxine doesn’t “top up” your thyroid…..it replaces it

Important to be on high enough dose levothyroxine

[Gal_Ka in reply to SlowDragon]

I see…however, I used to think if I am not symptomatic or I have rare symptoms then my dose is fine. Plus if you only do just a minimal blood tests panel - all seems more or less fine on paper as well.

The thing is how quickly your condition deteriorates if you are under medicated?

[tattybogle in reply to Gal_Ka]

high cholesterol should usually reduce when hypothyroidism is 'optimally treated'.

Yours isn't optimally treated at the moment with those results . (TSH over 2/ fT4 30% / fT3 0% )

and if your results have been similar for years on just 50mcg levo , then that explains why Levo use hasn't reduced cholesterol in the past.

GP's should be aiming to keep TSH below 2/ 2.5 (at the highest) in patients on levo..

Several GP updates have advised them of this (see links below) , but unfortunately the NHS basic guideline only tells them to keep it 'in range' .. so unless they go looking for further advice they won't know this , and therefore won't increase Levo when TSH is ' in range' unless the patient pushes them to do so .

~Advice for GP's to keep TSH lower in range , some taken straight from GP 'update' sources , one written specifically for GP's by Specialist Registrars in Cardiology and Endocrinology (includes ref. to high cholesterol) : healthunlocked.com/thyroidu.... ist-of-references-recommending-gps-keep-tsh-lower-in-range-

Symptoms are not he only issue to be considered when treating hypothyroidism , there are increase risks with 'higher ' TSH (even if it is still in range) even if there are no 'evident' symptoms .

Explanation of why higher in range TSH may not be 'optimal' ( the shoe size analogy):

healthunlocked.com/thyroidu...

[Gal_Ka in reply to tattybogle]

Thank you for your replay, lots of info to think about my next step.

[SlowDragon Ambassador]

what vitamin supplements are you currently taking

[Gal_Ka in reply to SlowDragon]

Right now I am on Vit C, NAC, zink, alpha lipoic acid, berberine with micropqq. I was thinking about wobenzym also but haven’t started yet. I usually rotate and try different supplements.